1. Antitumor Necrosis Factor Agents to Treat Endoscopic Postoperative Recurrence of Crohn's Disease: A Nationwide Study With Propensity-Matched Score Analysis
- Author
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Laura Ramos, Olga Benítez-Leiva, Iago Rodríguez-Lago, Manuel Barreiro-de Acosta, Luis Bujanda, Patricia Ramirez de la Piscina, Fiorella Cañete, Míriam Mañosa, Raquel Ríos León, Ramiro C González-Sueyro, Pilar López Serrano, Inflirecu study, Eva Iglesias-Flores, María José Casanova, Albert Villoria, Pablo Navarro, Antonio García-Herola, Isabel Pérez-Martínez, Carlos Taxonera, Jordi Gordillo, Eugeni Domènech, Jesús Barrio, Ana Gutiérrez, Pilar Nos, M Navarro-Llavat, and M Calafat
- Subjects
Male ,intestinal resection ,recurrent disease ,retrospective study ,Anti-Inflammatory Agents ,Logistic regression ,Gastroenterology ,immunology ,0302 clinical medicine ,Crohn Disease ,prevention ,colonoscopy ,Recurrence ,Interquartile range ,adalimumab ,Intestinal Mucosa ,risk ,Crohn's disease ,azathioprine ,Mercaptopurine ,drug effect ,clinical trial ,Colonoscopy ,TNF protein, human ,female ,Treatment Outcome ,mesalazine ,030220 oncology & carcinogenesis ,intestine mucosa ,Female ,Drug Therapy, Combination ,030211 gastroenterology & hepatology ,double-blind ,antiinflammatory agent ,Immunosuppressive Agents ,management ,medicine.drug ,combination drug therapy ,Adult ,medicine.medical_specialty ,Adolescent ,diagnostic imaging ,tumor necrosis factor ,mercaptopurine ,Article ,Young Adult ,03 medical and health sciences ,Internal medicine ,medicine ,Adalimumab ,Humans ,human ,procedures ,Propensity Score ,Retrospective Studies ,therapy ,Tumor Necrosis Factor-alpha ,business.industry ,Inflammatory Bowel Disease ,association ,natural-history ,Odds ratio ,immunosuppressive agent ,medicine.disease ,Infliximab ,Confidence interval ,multicenter study ,Concomitant ,pathology ,business - Abstract
INTRODUCTION: Patients with Crohn's disease experiencing endoscopic postoperative recurrence (POR) may benefit from antitumor necrosis factor (TNF) agents but scarce data on this are available. Our aim was to assess the efficacy of anti-TNF in improving mucosal lesions in patients with endoscopic POR. METHODS: Multicenter, retrospective, study of patients with Crohn's disease who underwent therapy with anti-TNF agents for endoscopic POR (Rutgeerts score > i1). Treatment outcomes were assessed by the findings in the last ileocolonoscopy performed after anti-TNF therapy was initiated. Endoscopic improvement and remission were defined as any reduction in the baseline Rutgeerts score and by a Rutgeerts score < i2, respectively. RESULTS: A total of 179 patients were included, 83 were treated with infliximab and 96 with adalimumab. Median time on anti-TNF therapy at the last endoscopic assessment was 31 months (interquartile range, 13-54). Endoscopic improvement was observed in 61%, including 42% who achieved endoscopic remission. Concomitant use of thiopurines and treatment with infliximab were associated with endoscopic improvement (odds ratio [OR] 2.15, 95% confidence interval [CI] 1.04-4.46; P = 0.03, and OR 2.34, 95% CI 1.18-4.62; P < 0.01, respectively) and endoscopic remission (OR 3.16, 95% CI 1.65-6.05; P < 0.01, and OR 2.01, 95% CI 1.05-3.88; P = 0.04, respectively) in the multivariable logistic regression analysis. These results were confirmed in a propensity-matched score analysis. DISCUSSION: In patients with endoscopic POR, anti-TNF agents improve mucosal lesions in almost two-thirds of the patients. In this setting, concomitant use of thiopurines and use of infliximab seem to be more effective in improving mucosal lesions.
- Published
- 2020